ADHD Policy & Procedure

USU Student Health Services (SHS) does not provide psychological assessment/evaluation for the diagnosis of Attention Deficit Hyperactive Disorder (ADHD). SHS will not manage and/or prescribe stimulant medications for the treatment of ADHD without formal assessment/evaluation of a diagnosis of ADHD. Further, SHS will only manage and/or prescribe stimulant medications for the treatment of ADHD with proper documentation of a history of ADHD diagnosis and treatment. Students are encouraged to continue obtaining stimulant medications for the treatment of ADHD from their current provider. However, SHS may provide ADHD medication for students in coordination with their current provider.

Students who are seeking ADHD services must follow the established guidelines:

Students with NO established formal assessment/evaluation for ADHD:

• Students will be referred to an outside neuropsychologist, psychiatrist, or psychologist for formal assessment/evaluation:
• Students must give consent from the provider for the documentation indicating their formal diagnosis to be released to SHS. It is the student's responsibility to get a copy of the assessment/evaluation report to SHS prior to their initial appointment if they want to seek on-campus treatment.
• Students must provide valid documentation* before the student will be contacted and scheduled for an intake with a provider.
  • No guarantee is made that the Psychiatrist, Nurse Practitioner, Physician, or Physician Assistant will prescribe the student's current medication or medication at all. The intake is for an evaluation only.
  • If students are prescribed stimulants, a consent form must be signed indicating their understanding of SHS's policy regarding stimulant usage

Students with established diagnosis and treatment, currently being prescribed stimulant medication and wishing to transfer their care to SHS:

• In order to transfer care of ADHD (i.e. prescription of stimulant medication) the student must submit valid documentation* verifying the diagnosis of treatment of ADHD. There must be evidence of assessment/evaluation within the last 5 years and the completed documents must be submitted to SHS.
• When documentation has been received and approved by SHS, the student will be contacted and scheduled for an intake with a medical staff member.
  • No guarantee is made that the Psychiatrist, Nurse Practitioner, Physician, or Physician Assistant will prescribe the student's current medication or medication at all. The intake is for an evaluation only.
  • If students are prescribed stimulants, a consent form must be signed indicating their understanding of SHS's policy regarding stimulant usage

Students who have been diagnosed in the past with ADHD but are not currently being prescribed stimulant medication:

• In order to begin treatment of ADHD (i.e. prescription of stimulant medication) the student must submit information verifying the diagnosis and past treatment of ADHD. The assessment/evaluation must be within 5 years of the current date and completed documents must be submitted to SHS. If the assessment/evaluation is older than 5 years, the student may be referred out for additional assessment/evaluation.
• When documentation has been received and approved by SHS, the student will be contacted and scheduled for an intake with a provider.
  • No guarantee is made that the Psychiatrist, Nurse Practitioner, Physician, or Physician Assistant will prescribe the student's current medication or medication at all. The intake is for an evaluation only.
  • If students are prescribed stimulants, a consent form must be signed indicating their understanding of SHS's policy regarding stimulant usage

Students who were diagnosed with ADHD prior to age 12 and are currently being treated for ADHD will be assessed individually by the ADHD treatment team.

Additional requirements

An amphetamine/stimulant medication use contract is to be signed by the student and scanned into their chart noting the specific expectations for continued medication management. This will delineate potential outcomes due to any deviations by the student from the contract.

Stimulant Medication Policy

Stimulant medications are frequently prescribed to treat ADHD. For many students they are highly effective. However, they are not without their risks.  They are controlled substance and carry abuse potential. This abuse potential can lead to diversion which has been see on college campuses especially around exam times.  Other students use these drugs recreationally. In an attempt to balance the important benefits stimulants can have for students with ADHD and to protect against abuse and diversion, the following policy has been created. Students will be asked to read, adhere to, and sign the policy statement:

1. Prescriptions can only be issued at a regularly scheduled appointment.
2. There are no early refills.
3. Lost prescriptions will not be replaced.
4. Stolen prescriptions will not be replaced.
5. Students will be monitored through the state registry to determine proper use of medication and/or their prescription habits.
   1. If students are receiving stimulants from other providers they will no longer receive prescriptions through SHS.
6. Students may be requested to submit a urine sample for drug abuse testing at any time while being treated for ADHD by a SHS provider. This will be randomly generated by medical record software.
   1. If student refuses drug testing or does not provide a sample within 36 hours of request, stimulant prescriptions will not be administered.
   2. The result of the drug test is confidential between the student and the medical provider.
   3. A failed drug screen will disqualify the student from further prescribing of any controlled substances from the student health center.
7. Any evidence of misuse through prescription forgery, sale, or diversion of psychostimulant medications will result in provider immediately informing police and local authorities of a possible felony. Subsequently, psychostimulants will be discontinued and no longer prescribed through SHS.

Additional Information

1. A copy of the psychological or psychoeducational evaluation report from the provider (i.e. psychologist or neuropsychologist) who diagnosed a student’s ADHD is required. Since there are numerous psychometric measures the following are listed as examples of the type of content to be covered in the assessment and should be considered exhaustive or specifically required:
   1. Client name, date of birth, and date of evaluation.
   2. Provider name (printed), office address and contact information, qualification of evaluator, signature and date of report
   3. Evaluation must include a reasonable combination of the following:
      1. Cognitive/intelligence test (WAIS-IV or Stanford-Binet 5, RIAS-2, Woodcock Johnson-IV)
      2. Achievement Test (Woodcock-Johnson-IV, WIAT)
      3. Test of Sustained Attention (TOVA or CPT)
      4. Self-report forms for ADHD (Brown, Connors) and collateral information from parents/partners (Brown, Connors). (However, assessments such as checklists, and rating scales are valuable, but will NOT be used as sole criteria for and ADHD diagnosis).
      5. Diagnostic interview with psychologist- with the expectation that the interview is a face-to-face/one-on-one interaction (Symptom limits reviewed asynchronously online are not acceptable).
      6. Measures of executive functioning (BRIEF, Kaufman, etc.)
      7. Measures of comorbidity to anxiety, depression substance use disorders (BSI, BAI, BDI, SASSI, etc.)
   4. Comprehensive diagnostic interview, which must include:
      1. Psychosocial and educational history
      2. Mental health and medical history (including current treatments/medications)
      3. Current symptoms
   5. Clinical evaluation/summary must include:
      1. All tests and scores
      2. Interpretation of test results
      3. Diagnosis
2. All assessment/evaluation reports and medication information will be maintained in the student’s electronic medical records by scanning of paper documents.
3. If sufficient documentation is not provided the USU Student Health Service will not prescribe treatment through the use of stimulant/amphetamine medication.
4. Students seeking psychological assessment/evaluation in the community may be provided with a list of local providers who offer this service. The list is offered as a courtesy by SHS and there is no compensation to the university if any of the providers are used.
5. Students may locate their own provider but must ensure that the chosen provider is aware of the required psychometric data that needs to be included, as described above.
6. USU SHS counselor and medical provider may recommend other courses of treatment and/or adjunctive treatment including, but not limited to:
   1. Medical treatment of depression, anxiety, bipolar disorder.
   2. Therapy for depression, anxiety.
7. Follow-up medication appointments are an expectation and requirement for continued medication management. It is the student’s responsibility to schedule appointments in the appropriate time frame as designated by the prescriber. The following items are general guidelines for continued medication management:
   1. Initial: Follow-up visits after the initial assessment may occur at least monthly, or as indicated by the provider, until the symptoms and medication dosage have been stabilized.
   2. Maintenance: Students being treated for ADHD with stimulant/amphetamine medications must be reevaluated in face-to-face follow-up by the USU SHS psychiatrist/provider at least every three months or as the provider deems necessary.
   3. Students weight and blood pressure will be monitored for any medication related side effects.
   4. Students will be required to have drug testing prior to and throughout the course of stimulant usage.

*Valid Documentation:

• Evidence of current impairment in two or more settings.
• A diagnostic interview containing self-report and third-party information.
• Use of an objective, professionally administered ADHD rating scale.
• Evidence of alternative diagnoses being ruled out.
• Internet checklists are not sufficient and do not meet the best practice standards.
• Neuropsychological or psychoeducational assessment.
• A specific diagnosis as per the DSM-5/ICD-10.

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